Objective To investigate the interaction between Notch and LPS-LPS-Toll like receptor-4（TLR4）-NF-κB inflammatory signaling pathways in HepG2 cells stimulated with lipopolysaccharide （LPS）.Methods HepG2 cells were cultured with LPS and cell RNAs were extracted,and Notch signaling pathway receptors and their ligands mRNA were detected by quantitative reverse transcription polymerase chain reaction. Western blot analysis was used to detect Notch intracellular domain（NICD） and NF-κB protein expression levels after the γ-secreting enzyme inhibitor （DAPT）,LPS or combination of LPS and DAPT activation,respectively.Results After LPS activation of HepG2 cells,the mRNA level of Notch 1 was 2.25 times（P<0.001）,Jag 1 was 2.47 times（P<0.001）,NOTCH 3 was 0.0700 times （P>0.05）,Jag 2 was 0.420 times （P>0.05）,and Dll 4 was 0.947 times （P<0.01） increased,while NOTCH 2 was 0.857 times（P<0.01）,NOTCH 4 was 0.283 times（P>0.05）,Dll 1 was 0.750 times（P<0.01）,and Dll 3 was 0.393 times（P>0.05） decreased;the expression of NICD and NF-κB proteins in LPS-intervened cells increased obviously,while those in DAPT-intervened cells decreased greatly as compared to those in the control. Conclusion Our findings reveals that the interaction might be going on between Notch and TLR4-NF-κB signaling pathways in HepG2 cells stimulated by LPS. The inhibition of Notch signaling pathway could significantly alleviate the inflammatory response caused by LPS-TLR4.

Objective To explore the protective effect of bee venom hemolysin on rats with nonalcoholic fatty liver disease （NAFLD）.Methods Forty male SD rats were randomly divided into control,model,low-dose and high dose of bee venom hemolysin-intervened groups. Rats were fed with high fat to establish the NAFLD models,and the bee venom hemolysin peptide at doses of 10 μg·kg^-1 and 100 μg·kg^-1 or saline were subcutaneously injected daily for 12 weeks. Hepatic expression of nuclear factor-erythroid 2 p45-related factor 2 （Nrf2） and heme oxygenase-1（HO-1） were detected by Western bloting.Results The body weight and liver mass of rats in high dose of bee venom hemolysin-intervened group were（380.2±20.8） g and（10.4±1.3） g,significantly lower than（435.2±22.1） g and （14.3±1.4） g in the model （P<0.05）,serum AST and ALT levels were （88.0±10.4） U/L and （49.3±6.2） U/L,much lower than （159.7±18.9） U/L and （77.7±6.8） U/L in the model （P<0.05）,blood glucose,TC,TG,and LDL-C levels were（8.7±1.8） mmol/L,（1.6±0.2） mmol/L,（0.8±0.1） mmol/L and （0.3±0.1）mmol/L,significantly lower than （18.3±2.4） mmol/L,（2.8±0.3） mmol/L,（1.5±0.2） mmol/L and （0.5±0.1）mmol/L,respectively in the model （P<0.05）,serum superoxide dismutase（SOD）,malondialdehyde（MDA） and glutathione（GSH） levels were （82.1±6.6）U/L,（6.3±0.8）nmol/mL and （8.7±0.9） mmol/L,significantly different as compared to （30.4±5.3）U/L,（13.1±1.6）nmol/mL and（2.3±0.5）mmol/L in the model（P<0.05）,hepatic expression of Nrf2 and HO-1 were （1.4±0.2） and （1.2±0.1）,significantly intensified as compared to（0.3±0.1） and （0.3±0.1） in the model （P<0.05）. Conclusion Bee venom hemolytic peptide might alleviate hepatic steatosis in rats with non-alcoholic fatty liver disease and improve liver function,and the mechanism might be related to the regulation of Nrf2 and HO-1 expression and relieve oxidative stress injury.

Objective To investigate the effect of Chinese herbal medicine on intestinal microflora in mice with D-galactosamine/LPS-induced acute liver failure（ALF）.Methods Forty-eight mice were randomly divided into control,model,high-dose herbal medicine,middle-dose herbal medicine and low-dose herbal medicine,and Lizhuchangle group,with 8 mice in each group. The mice were given intragastric administration once daily of normal saline,herbal or lizhuchangle for 8 days,and then,the model was established by intraperitoneal injection of D-galactoside and lipopolysaccharide. The change of intestinal microflora in each group was detected by viable plate count.Results The liver pathology examination in the model group showed obviously hemorrhage and necrosis,suggesting the model was successfully established;serum ALT level in the model group was（1983.3±629.0） U/L, significantly higher than （36.9±7.5） U/L in the control （P<0.001）,the liver index was （6.7±0.6） %,significantly higher than （5.2±0.3） % in the control （P<0.001）,the number of escherichia coli was （8.7±0.5） CFU/feces and of enterococcus was （9.5±0.3） CFU/feces,were significantly higher than （7.6±0.9） CFU/feces （P<0.01） and （8.8±0.2） CFU/feces （P<0.001） in the control,while the number of lactobacillus was （9.3±0.3） CFU/feces and lifidobacteria was （10.1±0.4） CFU/feces,significantly lower than （10.4±0.5） CFU/feces （P<0.001） and （11.2±0.5） CFU/feces（P<0.001） in the control;the liver injuries and abnormal changes of intestinal microflora in herbal medicine-intervened groups improved obviously as compared with in the model group （P<0.001）. Conclusion The administration of Chinese herbal medicine might improve the liver injuries and restore the abnormal changes of intestinal flora in mice with acute liver failure.

Objective To optimize the luciferase bioluminescence reporting system and to investigate its application in xenografted human HepG2 cell transplantation in nude mice.Methods A certain number of HepG2-Luc cells with stable expression of luciferase（fixed luciferase amount） were conducted for optimization of luciferin and ATP concentration. The sensitivity and luminescence intensity of the optimized substrate and ATP concentration were analyzed in vivo for the tumor cell imaging in nude mice.Results The optimal concentration of luciferin was 1.25 mg/ml and the optimal concentration of ATP buffer was 12.5 μM in in vivo imaging experiments;the intensity of subcutaneous injection of 2×10⁶ HepG2-Luc cells was 484645,while it became 1483024 when the optimized system was used;the ratio of signal intensity between experimental and control mice was 0.11,while it became 0.67 after the optimized system was used,suggesting that in vivo imaging with this optimized luciferase reporting system could significantly improve the sensitivity of tumor detection and prolong the luminescence time in nude mice. Conclusion An optimized luciferase bioluminescence reporting system is established,which might be used in in vivo study for tumor detections.

Objective To explore the changes of intestinal microecology in mice with xenograft hepatoma intervened by sodium norcantharidate.Methods Twelve Kunming mice were randomly divided into sodium nor-cantharidate-intervend,saline-intervend and control groups,and a mouse model of H22 hepatoma xenograft was es-tablished in sodium norcantharidate and saline groups. The mice were normally fed for 2 weeks after the success-ful establishment of the model. Then,the fecal samples were collected and Illumina miseq 2×300 bp high -throughput sequencing and bioinformatics analysis were performed.Results Every samples in each group con-tained abundant species,and species abundance and evenness tended to be consistent；there were significant differ-ences as respect to bacterial communities among sodium norcantharidate,saline and control group；at phylum,the most significantly different bacterial community was Proteobacteria and in sodium norcantharidate-intervend group,the proportion of Proteobacteria was 9.1%,significantly higher than those in saline group or the control group（2.8% and 2.3% ,respectively，P <0.05）;in genus，the different bacterial community included Bacteroides，etc；in saline-intervened group，the proportion of Bacteroides was 26.8%,significantly higher than those in sodium norcan-tharidate group or the control group （13.2% and 6.8%,respectively,P<0.05）. Conclusion There is a obvious change in intestinal microecology in mice with hepatoma xenograft receiving sodium norcantharidate intervention,which might be related to the anti-tumor effect of this agent.

Objective To investigate the efficacy of peginterferon alfa-2b treatment and affecting response factors in patients with chronic hepatitis B （CHB）.Methods A total of 105 patients with CHB were recruited in our hospital between June 2015 and December 2017,and all patients were treated by peginterferon alfa-2b for 48 weeks. Serum HBV DNA,HBeAg and HBsAg,as well as interferon-γ-induced protein-10（IP-10）,interferon-α/β receptor （IFNAR）,and T helper cell 17 （Th-17） were detected. Multivariate Logistic regression analysis was applied to demonstrate the prognostic factors of response to peginterferon alfa-2b therapy in patients with CHB.Results At the end of treatment regimen,56 patients（53.3%）,while 49 failed to respond to peginterferon alfa-2b therapy;there were no significant differences as respect to blood platelet counts,serum albumin,total bilirubin,prothrombin time,IFNAR-α and IFNAR-β between responders and non-responders（P>0.05）,while the baseline white blood cell counts,serum alanine aminotransferase,HBV DNA loads,HBsAg,IP-10,IL-17A and IL-17F in the responded group were（5.6±1.7）×10⁹/L,（108.6±9.5） U/L,（5.4±0.8） lg copies/ml,（4.6±0.9） lg IU/ml,（324.5±86.9） pg/ml,（3.2±0.6） mean fluorescene intendity （MFI） and（3.1±0.5） MFI in responders,significantly different as compared to（6.4±1.9）×10⁹/L,（82.5±10.0） U/L,（6.1±0.9） lgcopies/ml,（5.8±1.1） lg IU/ml,（381.4±79.6） pg/ml,（3.8±0.7） MFI and （3.6±0.7） MFI in the non-responder group （P<0.05）;multivariate Logistic regression analysis showed that serum HBV DNA loads,HBsAg,IP-10,IL-17A and IL-17F were the prognostic factors of response in patients with CHB treated with α-interferon （P<0.05）. Conclusion Serum HBV DNA,HBsAg,IP-10 and Th-17 are the prognostic factors affecting the response in patients with CHB after treatment of α-interferon,and detection of serum IP-10 and Th-17 might help predict the efficacy of peginterferon alfa-2b treatment.

Objective To evaluate the value of serum angiopoietin-like protein 2（ANGPTL2） and Golgi protein 73 （GP73） levels in the diagnosis of liver fibrosis in patients with chronic hepatitis B（CHB）.Methods 117 patients with CHB were recruited in our hospital between March 2015 and October 2017,and serum ANGPTL2 and GP73 levels were detected by enzyme-linked immunosorbent assay. The efficacy of serum ANGPTL2 and GP73 levels in the diagnosis of significant hepatic fibrosis and cirrhosis were evaluated by the area under receiver operating characteristic curve （ROC）.Results Serum levels of ANGPTL 2 and GP73 in 15 CHB patients with S3-S4 were （9.1±2.4） ng/ml and （84.9±15.2） ng/ml,significantly higher than （6.7±2.3） ng/ml and （65.1±14.8） ng/ml （P<0.05） in 78 patients with S1-S2 or （4.4±1.4） ng/ml and （53.7±14.3） ng/ml in 24 patients with S0 （P<0.05）;based on serum ANGPTL2 levels equal to 8.6 ng/mL and equal to 9.6 ng/mL or serum GP73 level equal to 75.6 ng/ml and equal to 103.5 ng/mL as the cut-off-value for the diagnosis of significant hepatic fibrosis （equal to or greater than S3） and liver cirrhosis, the diagnostic efficacy of serum ANGPTL2 levels was not superior to serum GP73（Z=1.872,P=0.061;Z=0.328,P=0.743）;the diagnostic value of combination serum ANGPTL2 and GP73 levels for significant hepatic fibrosis was superior to either serum ANGPTL2 level or serum GP73 level alone,e.g. AUCcombination>AUCANGPTL2（Z=3.310,P=0.001） or AUCcombination>AUCGP73（Z=2.004,P=0.045）,while the diagnostic efficacy of combination serum ANGPTL2 and GP73 levels for liver cirrhosis was not superior to either serum ANGPTL2 or GP73 alone（Z=1.471,P=0.141;Z=1.575,P=0.115）;the efficacy of combination of serum ANGPTL2 and GP73 levels in diagnosis of liver fibrosis was not superior to FIB-4 or APRI（Z=0.869,P=0.386;Z=0.492,P=0.623） and it also not better than FIB-4 or APRI in diagnosis of liver cirrhosis（Z=1.834,P=0.067;Z=0.610,P=0.512）. Conclusion Serum levels of ANGPTL2 and GP73 change obviously in patients with CHB,which might hint hepatic fibrosis and be applied to evaluate the liver fibrosis staging.

Objective To investigate the effect of combination of entecavir and herbal medicine on negative emotion in patients with chronic hepatitis B （CHB） and depression.Methods 183 CHB patients with depression were admitted to our hospital between June 2014 and October 2016. The patients were randomly divided into observation （n=92） and control （n=91） groups,and received combination of entecavir and herbal medicine and entecavir alone,respectively for eight weeks. The positive/negative emotion scale （PANAS,NA） and Hamilton depression scale（HAMD） were used to evaluate the negative emotion,TCM syndrome was evaluated by using Likert’s five-point scoring method and the quality of life was evaluated by SF-36 health questionnaire.Results At the end of 8 week observation,serum amimotransferase levels in the combination group were significantly lower than in the control （P<0.05）;the NA score was （10.3±2.5） and the HAMD score was （8.1±1.4）,both significantly lower than （13.2±3.1） and （10.6±1.7） in the control （P<0.05）;the spiritual depression,facial yellow,abdominal distension and watery feces scores were （2.9±0.8）,（3.4±0.9）,（2.7±0.8） and （2.8±0.8）,much lower than （3.4±0.5）,（3.9±0.6）,（3.5±0.6） and （3.6±0.7）,respectively,in the control （P<0.05）;the social activity,physical function,physical pain,spiritual health,total health,physical manifestation,energy and emotional function scores out of quality of life were（56.3±11.4）,（57.4±12.5）,（52.6±12.3）,（56.8±13.1）,（59.1±9.5）,（55.5±13.6）,（55.4±13.1） and （58.6±13.2）,all significantly higher than （51.5±12.3）,（53.6±12.8）,（60.9±11.7）,（50.4±13.9）,（52.8±10.4）,（51.5±13.2）,（53.7±13.3） and （53.5±13.8）,respectively,in the control （P<0.05）. Conclusions Our observation suggest that at the basis of routine antiviral treatment,the combination of Chinese herbal medicine might effectively eliminate the negative emotion in patients with CHB and depression,it could also obviouly improve the liver function tests,reduce the TCM syndrome scores with little adverse reactions,which needs long-term and multi-central investigation.

Objective To explore the clinical efficacy of single,double and stretch index model under diffusion weighted imaging （DWI） of MRI in evaluating liver fibrosis in patients with chronic hepatitis B （CHB）.Methods 77 patients with CHB and 20 healthy persons were recruited in this study between February 2014 and September 2017. All patients received liver biopsies and individuals in both groups received MRI examination,and the parameters,e.g. ADCst as surface diffusion coefficient,Dt as real diffusion coefficient,Dp as false diffusion coefficient,f as perfusion related volume fraction,DDC as diffusion distribution index and α as water molecule diffusion heterogeneity index.Results The ADCst,Dt,f and DDC in patients with CHB were（0.899±0.080）×10^-3 mm²/s,（0.591±0.092）×10^-3 mm²/s,（32.374±7.472）×10^-3 mm²/s and（1.103±0.257）×10^-3 mm²/s,significantly lower than【（0.986±0.095）×10^-3 mm²/s,（0.704±0.073）×10^-3 mm²/s,（39.686±5.871）×10^-3 mm²/s and （1.394±0.243）×10^-3 mm²/s,P<0.05】 in healthy persons;there were significantly statistical differences as respect to ADCst,Dt,f and DDC in 25 patients without liver fibrosis,29 with significant liver fibrosis and 23 with liver cirrhosis （P<0.05）;the AUC of ADCst,Dt,f and DDC in diagnosing liver fibrosis were 0.841,0.934,0.770 and 0.926,respectively. Conclusion The application of double and stretch index models in diagnosing liver fibrosis in patients with CHB have a promising results,which might be validated in multicentral clinical trials.

Objective To investigate the diagnostic value of portal vain by ultrasonography and serum matrix metalloproteinase-2 （MMP-2） and tissue inhibitor of metalloproteinase-2（TIMP-2） in patients with chronic hepatitis B （CHB）.Methods Forty-three patients with CHB and 40 healthy controls were enrolled in our hospital between May 2014 and May 2018,and all patients underwent liver biopsy for liver fibrosis staging. B-ultrasound was performed in all subjects,and the width of portal vein, the width of the splenic vein,and the thickness of the spleen were measured. Serum MMP-2 and TIMP-2 levels as well as hyaluronic acid （HA）,laminin （LN）,type IV collagen（IV-C） and III procollagen amino terminal peptide （P III P） were assayed.Results Liver biopsy results showed that there were 13 patients with S0-S1,11 patients with S2,14 patients with S3,and 5 patients with S4;From S2 to S4 with the increasing degree of liver fibrosis,the portal vein width,splenic vein width and spleen thickness increased gradually,and the differences between patients with different liver fibrosis was statistically significant（P<0.05）;Serum MMP-2 levels in patients with S0-1,S2,S3 and S4 were（291.5±35.3） mg/L,（357.7±32.5） mg/L,（446.8±47.1） mg/L and （595.3±85.4） mg/L,and serum TIMP-2 levels were （154.3±28.6）mg/L,（210.7±24.1） mg/L,（255.7±31.9） mg/L and （302.5±74.3） mg/L,significantly higher than（246.5±32.1） mg/L and （126.5±20.1） mg/L（P<0.05） in healthy persons;serum HA,LN,IV-C and P III P levels in patients with significant liver fibrosis were higher than those in healthy control （P<0.05）. Conclusion The examination of portal vain parameters by ultrasonography and serum liver fibrosis determination might help predict the intrahepatic liver fibrosis in patients with CHB.

Objective The aim of this study was to investigate the difference in predicting efficacy of significant liver fibrosis by noninvasive liver fibrosis index in different hospitals.Methods Clinical data of patients with chronic HBV infection from two hospitals were retrospectively analyzed,and the liver biopsies were done in all the patients. The APRI,FIB-4 and liver stiffness measure（LSM） were obtained. The diagnostic performance was analyzed by ROC curve.Results We enrolled 327 patients （group A） and 250 patients （group B） from two hospitals respectively;there were significant differences as respect to liver pathological data and LSM in the two groups（both P<0.001）,while there were no significant differences respect to APRI or FIB-4 in the two groups （P=0.547 and P=0.578）;as for distinguishing liver fibrosis S0-1 and ≥S2,the APRI in group A was set at 0.14 and 0.18,in group B was 0.15 and 0.24,the FIB-4 in group A was 0.98 and 1.26, in group B was 0.93 and 1.50,while the LSM in group A was set at 5.2 kPa and 6.8 kPa,and in group B was 7.2 kPa and 9.0 kPa（P<0.001）,respectively;the cut-off-values of APRI in group A and group B were 0.105 and 0.145,of FIB-4 were 0.675 and 0.775,and of LSM were 4.650 and 6.345,respectively,their sensitivities and specificities in predicting significant liver fibrosis of patients from the two hospitals were at about 85% and 24% to 46%. Conclusion The diagnostic performance of APRI,FIB-4 and LSM in predicting significant liver fibrosis might varies,because of some uncontrollable factors. Hence,the cut-off-value of each noninvasive index might be set in every hospital.

Objective To compare the clinical features of infants with human cytomegalovirus （HCMV) infection and of infantile hepatitis syndrome（IHS）.Methods 212 infants with HCMV infection, 194 infants with HIS and 194 healthy infants were recruited in our hospital between September 2015 and July 2017. Urine HCMV DNA was detected by PCR,and serum anti-HCMV IgM was assayed by ELISA.Results The incidences of fever,rash and lymphadenectasis in infants with HCMV infection were 82.1%,45.3% and 50.5%,significantly higher than 34.5%,21.1% and 33.5% in infants with IHS,respectively（P<0.05）,while jaundice and hepatosplenomegaly were 45.8% and 37.3%,much lower than 100.0% and 67.5%,respectively,in infants with IHS（P<0.05）;urine HCMV DNA positive rate was 80.7% and serum anti-HCMV-IgM positive rate was 41.0% in infants with HCMV infection,significantly higher than 8.2% and 3.6% in infants with IHS or 1.5% and 0.5% in healthy infants（P<0.05）;serum alanine aminotransferase （ALT） and aspartate aminotransferase（AST） levels in the two groups were not significantly different（P>0.05）,while serum bilirubin level in infants with HCMV infection at presentation was （32.6±8.4） μmol/L,which decreased to normal level after treatment,and serum bilirubin level in infants with IHS at presentation was （73.9±8.6） μmol/L,which decreased to （37.6±5.4） μmol/L two weeks after treatment;at the end of six month followed-up,five （2.4%） died of pulmonary infection or cardiac failure in infants with HCMV infection and all infants with IHS recovered. Conclusion The clinical manifestations of infants with HCMV infection are characterized by fever rash and lymphadenectasis,obviously different from those with IHS,in which the jaundice and hepatosplenomegaly are outstanding. The HCMV infection might lead to IHS in infants,and the severe case might be fatal, while the outcomes of infants with IHS is good.

Objective The purpose of this study was to investigate the changes of serum cytokines and intestinal flora distribution in patients with alcoholic liver disease（ALD）.Methods 34 patients with ALD and 34 healthy individuals were recruited in our hospital,and serum tumor necrosis factor-α（TNF-α）,interleukin-6 and NF-κB levels were detected by ELISA. The intestinal flora distribution were separated and characterized.Results Fasting blood glucose,total cholesterol,TG,LDL-C and HDL-C levels in patients with ALD were（5.3±1.8） mmol/L,（2.3±0.9） mmol/L,（5.1±1.8） mmol/L,（2.1±0.6） mmol/L and（0.9±0.2） mmol/L,not significantly different as compared to（5.2±1.3） mmol/L,（2.2±1.1）mmol/L,（5.1±1.6） mmol/L,（2.0±1.5） mmol/L and （0.8±0.1） mmol/L in the healthy persons（P>0.05）;serum ALT,AST,GGT and bilirubin levels were（99.5±41.8） U/L,（106.9±55.7） U/L,（229.4±148.3） U/L and（35.3±8.6） μmol/L,significantly higher than【（35.6±9.7） U/L,（36.2±8.4） U/L,（46.7±14.5） U/L and（16.4±2.3） μmol/L,respectively,P<0.05】 in the control;serum TNF-α,IL-6 and N F-κB levels were （9.8±3.4） ng/L,（0.9±0.4） pg/mL and（3.7±6.3） ng/L,much higher than 【（5.7±2.1） ng/L,（0.5±0.3） pg/mL and （0.5±0.4） ng/L,P<0.05】 in the control;the enterococcus faecalis and escherichia Coli counts in patients with ALD were （8.7±1.4） lg CFU/g/g and （7.6±1.2） lg CFU/g/g significantly higher than [（7.2±1.3） lg CFU/g/g and （6.6±1.5） lg CFU/g/g,respectively,P<0.05] in the control,while the bifidobacterium counts were（7.1±1.2） lg CFU/g/g,much lower than [（8.9±1.3） lg CFU/g/g,P<0.05] in the control. Conclusion The intestinal flora disorders and high levels of serum cytokines exist in patients with ALD,which might take part in the pathogenesis of the disease.

Objective To investigate serum 25-（OH）D₃ and interleukin-17（IL-17） levels in obese children with nonalcoholic fatty liver disease（NAFLD）.Methods Sixty-two obese children were enrolled in this study between January 2014 and December 2017,and out of them,36 cases were diagnosed as nonalcoholic fatty liver （NAFL） and 26 were nonalcoholic steatohepatitis （NASH）. Thirty healthy children were selected as control. Serum IL-17 and 25-（OH）D₃ levels were assayed by ELISA.Results Serum 25-（OH）D₃ level in children with NAFL was（15.2±2.1） ng/mL,and in children with NASH was （9.6±1.3） ng/ml,both significantly lower than （26.3±2.3） ng/mL in healthy children,while serum IL-17 levels were（17.1±7.8） μg/L and （36.2±12.6） μg/L,both significantly higher than（1.4±0.5） μg/L in healthy children（P<0.05）;serum ALT and AST levels in children with moderate NAFLD were （54.1±15.4） U/L and （46.5±12.6） U/L,and were （117.1±37.1） U/L and （78.5±31.0） U/L in children with severe NAFLD,all significantly higher than （33.4±4.6） U/L and （30.5±2.9） U/L in kids with mild NAFLD（P<0.05）;serum 25-（OH）D₃ level in children with moderate NAFLD was（10.2±1.4） ng/ml and in children with severe NAFLD was（8.4±1.1） ng/ml,both significantly lower than （15.8±2.0） ng/ml in children with mild NAFLD（P<0.05）,while serum IL-7 levels were（22.2±6.3）μg/L and （39.6±9.2） μg/L,respectively,significantly higher than （13.5±3.5） μg/L in children with mild NAFLD （P<0.05）. Conclusion Serum 25-（OH）D₃ levels decrease and serum IL-17 levels increase in obese children with NAFLD,which might be new indicators for supervision of disease progress.

Objective To investigate the value of controlled attenuation parameter （CAP） in diagnosis of individuals with liver steatosis （S） by using Fibrotouch in comparison to liver biopsy.Methods 63 suspected individuals with liver steatosis were enrolled in this study,and all of them received liver biopsies and Fibrotouch measurement for CAP within 2 weeks after liver biopsy. Multiple stepwise regression analysis was used to identify the influencing factors of CAP and establish regressive equation. The receiver operating characteristic（ROC） and the area under ROC（AUROC） were calculated to determine the optimal cut-off value of CAP for diagnosis of liver steatosis.Results Based on liver histopathological examination,the S0 was found in 36（57.1%） and individuals with NAFLD in 27;out of them,we demonstrated S1 in 12（19.1%）,S2 in 9（14.3%） and S3 in 6（9.5%）,with the CAP of （200.2±21.2） dB/m,（228.7±51.7） dB/m,（259.4±29.1） dB/m and （320.5±22.4） dB/m,respectively;the CAP in individuals with NAFLD was positively correlated to body mass index （BMI,r=0.503,P=0.000） and liver steatosis（r=0.761,P=0.000）,and BMI and liver steatosis were the independent predicting factors for CAP;the cut-off-value of CAP in diagnosing S1,S2 and S3 were 212 dB/m,246 dB/m and 287 dB/m,with the sensitivity of 81.5%,86.7% and 100.0% and specificity of 80.6%,91.7% and 96.5%,respectively. Conclusion FibroTouch measurement might help diagnose liver steatosis with high efficacy,which warrants further investigation.

Objective The aim of this study was to investigate the influence of ademetionine combined with polyene phosphatidylcholine on clinical efficacy and laboratory index in patients with intrahepatic cholestasis of pregnancy.Methods 84 patients with intrahepatic cholestasis of pregnancy were recruited in this study between January 2016 and October 2018,and were randomly divided into control group （n=42 patients）,receiving ademetionine alone,and observation group（n=42 patients）,receiving combination of ademetionine and polyene phosphatidylcholine for two weeks. The Ribaha score was performed for pruritus estimation,and serum interleukin-1 2（IL-12）,tumor necrosis factor-α（TNF-α） and suppressor of cytokine signaling （SOCS3） were detected by ELISA. The pregnant outcomes in the two groups were compared.Results The disappearance times of pruritus and jaundice in observation group were （4.3±1.0） d and （6.1±1.4） d,significantly shorter than（7.2±1.9）d and （8.4±2.6）d,respectively,in the control group（P<0.05）;the Ribaha score in the observation group at the end of the treatment was （0.5±0.1） point,significantly lower than （1.1±0.2） point in the control group;serum levels of TAB,AST and ALT in the observation group at the end of the treatment were （14.9±3.4）μmol/L,（65.3±14.6）U/L and （75.9±14.4） U/L,all significantly lower than（23.3±7.9） μmol/L,（92.04±18.3） U/L and（130.7±18.5） U/L,respectively,in the control group（P<0.05）;serum levels of IL-12 and TNF-α in the observation group were （13.1±1.4） pg/ml and （44.3±6.0）pg/ml,both significantly lower than （28.2±2.9） pg/ml and （69.04±7.3） pg/ml in the control （P<0.05）,while serum SOCS3 level in the observation group after treatment was （420.9±48.4） pg/L,significantly higher than （336.7±40.5） pg/L in the control group（P<0.05）;the incidence of premature delivery,amniotic fluid contamination,fetal distress and postpartum hemorrhage in the observation group were 19.1%,2.4%,0.0% and 7.1%,all significantly lower than 45.2%, 11.9%,11.9% and 21.4% in the control group（P<0.05）. Conclusion Combined regimen with ademetionine and polyene phosphatidylcholine in treatment of patients with intrahepatic cholestasis of pregnancy could efficiently promote rehabilitation process,relieve itching symptoms, protect liver function and might be helpful to improve pregnancy outcomes. The key mechanism for good efficacy for the treatment of this entity might be closely related to the regulation of inflammatory cytokine and SOCS3 level balance.

Objective To explore the risk factors for occurrence of hyperbilirubinemia in neonates.Methods 86 neonates with hyperbilirubinemia and another 86 healthy neonates were recruited in the Department of Neonatology in our hospital between May 2015 and February 2018,and the Logistic analysis were applied for the analysis of risk factors.Results The proportion of caesarean delivery,short gestational age and decreased body mass at birth in neonates with hyperbilirubinemia were significantly higher than in healthy neonates（P<0.05）;serum level of myoglobin and prealbumin in neonates with hyperbilirubinemia were（37.5±13.6） U/L and（79.9±23.5） U/L,much lower than [（63.2±18.4） U/L and （108.6±27.3）U/L,P<0.05],serum GGT and AST levels were （141.7±45.9） U/L and （39.8±13.1）U/L,significantly higher than[113.6±39.3） U/L and（33.4±12.6） U/L,respectively,P<0.05] in the healthy neonates;multivariate Logistic regression analysis showed that body mass at birth（OR=6.2,P=0.003）,gestational age（OR=2.8,P=0.004）,myoglobin （OR=3.4,P<0.001）,prealbumin （OR=2.9,P=0.001）,GGT（OR=3.2,P=0.011）,AST（OR=3.7,P=0.024） and PT were the risk factors for the occurrence of hyperbilirubinemia in neonates. Conclusion The liver function index in neonates with hyperbilirubinemia are damaged,and monitoring the risk factors related to hyperbilirubinemia and taking timely measures to intervene are helpful to reduce the incidence of untoward outcomes.

Objective The aim of this study was to investigate diagnostic performance of Paris criteria in Chinese patients with autoimmune hepatitis/primary biliary cholangitis overlap syndrome（AIH/PBC OS）.Methods We retrospectively analyzed the clinical data of 24 patients with PBC and 16 with AIH/PBC OS diagnosed based on Paris' criteria,and 14 patients with PBC underwent liver biopsies.Results Serum bilirubin,ALT,GGT and IgG levels in 16 patients with AIH/PBC OS were（45.3±48.3） μmol/L,（236.8±71.8） U/L,（305.3±258.5） U/L and （25.3±9.9） g/l,significantly different as compared to【（53.4±57.8） μmol/L,（77.5±71.7） U/L,（389.2±324.3） U/L and （13.9±6.0） g/l,respectively,P<0.05】 in 24 patients with PBC; the prevalence of serum ANA,AMA and AMA-M2,but SMA（43.8% in patients with AIH/PBC OS vs. 4.2% in patient with PBC） between the two groups were not significantly different（P>0.05）;we modified five patients' diagnosis from PBC to AIH/PBC OS as the liver histopathological evidence proved,while serum ALT levels in them were 40.0U/L,82.8U/L,94.1 U/L,162.1 U/L and 117.2 U/L,much lower than 5×ULN. Conclusion For the diagnosis of Chinese patients with AIH/PBC OS,we strongly recommend liver biopsy in order not to miss diagnosis.

Objective To investigate the efficacy of plasma exchange （PE） and continuous plasma dialysis filtration （CPDF） in the treatment of patients with acute-on-chronic liver failure （ACLF）.Methods 92 patients with ACLF were recruited between March 2012 and April 2017,and 46 patients in the control was treated with routine supporting treatment and another 46 in the observation was treated with combination of PE and CPDF at the basis of conventional treatment. Serum cytokine,endotoxin,aromatic and branched-chain amino acid levels were assayed.Results After treatment,the international standardized ratio（INR） of prothrombin time and total serum bilirubin in the observation group were significantly lower than while serum albumin level were significantly higher than in the control（P<0.05）;serum tumor necrosis factor,interleukin （IL）-6 and IL-8 levels in the observation group were significantly lower than those in the control group [（68.9±43.3） pg/ml vs.（89.7±39.5） pg/ml,（53.3±39.7） pg/ml vs. （69.4±41.2） pg/ml,and （271.7±135.4） pg/ml vs. （307.6±147.2） pg/ml, P<0.05];blood endotoxin level was 0.2（0.2,0.4）EU/ml,much lower than 【1.1（0.8,1.7） EU/mL,P<0.05】,blood ammonia level was （64.8±19.4） μg/L,much lower than【（80.3±31.1） μg/L,P<0.05】,and aromatic amino acid levels was 2.1（1.5,2.7） mg/dL,much lower than 【（2.3（1.8,2.5） mg/dL,P<0.05】,while branched-chain amino acid levels was（2.6±0.5） mg/dL,much higher than【（2.1±0.1）mg/dL,P<0.05】 in the control;the fatality rates in the two groups at the end of six month treatment were not significantly different （32.6% vs. 43.5%,P>0.05）. Conclusion The application of PE and CPDF in treatment of patients with ACLF might decrease blood cytokine,endotoxin,ammonia and aromatic amino acid levels,which warrants further investigation for their clinical efficacy.

Objective To investigate the factors impacting the prognosis of patients with hepatitis B-induced acute-on-chronic liver failure（ACLF）.Methods 120 patients with hepatitis B-induced ACLF were admitted to our hospital between May 2014 and May 2017,and the clinical materials of all patients were retrospectively analyzed. All patients received conventional comprehensive medical treatments. The factors affecting prognosis was found by binary multivariate Logistic analysis.Results At the end of three to six month treatment,52 patients with ACLF（43.3%） survived and 68（56.7%） dies;at presentation, the gender,disease period,anti-viral therapy and artificial liver supporting approaches between the survivals and dead were not significantly different（P>0.05）,while the percentage of older than 50 yr and the incidence of complications in the survivals were significantly lower than those in the dead （40.4% and 46.1% vs. 61.8% and 79.4%,P<0.05）;serum PAB,TBA,BUN,Cr and HBV DNA levels in the two groups were not significantly different（P>0.05）,while serum bilirubin and prothrombin time in the survivals were significantly lower than in the dead（P<0.05）,and serum albumin,cholinesterase,total cholesterol and alpha-protein levels in the survivals were significantly higher than those in the dead（P<0.05）;the incidences of hepatic encephalopathy,hepatorenal syndrome,blood electrolyte imbalance and various complications in the survival group were 7.7%,1.9%,15.4% and 11.5%,much lower than 45.6%,14.7%,39.7% and 26.5% in the dead,respectivley （P<0.05）,while the incidences of upper gastrointestinal hemorrhage and spontaneous bacterial peritonitis in the two groups were not significantly different （P>0.05）;the Logistic analysis showed that the patients’age,blood prothrombin time, hepatic encephalopathy,electrolyte imbalance and complications were the independent factors influencing the prognosis of patients with hepatitis B-induced ACLF. Conclusion The clinicians should take the influencing factors of prognosis into consideration for early diagnosis and appropriate management of patients with ACLF in clinical practice to improve the survivals,which might include decreasing the occurrence of related complications and promoting liver regeneration in time.

Objective To investigate the changes of serum IL-10 and soluble intercellular adhesion molecule-1 （sICAM 1） levels in patients with hepatitis B-induced liver cirrhosis （LC）.Methods A total of 79 patients with hepatitis B-induced LC, including 31 with Child-Pugh class A, 25 with Child-Pugh class B and 23 with Child-Pugh class C,were enrolled in our hospital between September 2014 and August 2016, and 23 healthy persons were selected as control. Serum interleukin（IL）-2,IL-6,IL-10 and sICAM 1 levels were detected by enzyme-linked immunosorbent assay.Results Serum IL-10 levels in patients with compensated and decompensated LC were （43.5±8.4） g/L and （55.8±6.1） g/L,respectively,much lower than （247.1±43.4） g/L （P<0.01） in healthy persons,while serum IL-2,IL-6 and sICAM-1 levels were （148.1±21.3） g/L,（43.5±8.4） g/L and （298.5±85.7）ng/mL,and （180.6±17.1） g/L,（55.8±6.1） g/L and （685.4±164.8） ng/mL, respectively,significantly higher than （22.6±6.0）g/L,（6.6±1.5） g/L and （158.7±21.5） ng/mL in healthy control （P<0.05）;serum IL-10 level in 23 patients with Child-Pugh class C was（84.3±11.4） g/L,much lower than（121.3±14.6） g/L in 31 patients with Child-Pugh class A or（101.4±12.6） g/L in 25 with Child-Pugh class B （P<0.05）,while serum IL-2,IL-6 and sICAM-1 levels were （182.7±31.4） g/L,（57.3±7.3） g/L and（665.0±135.5） ng/mL,much higher than （138.4±19.6） g/L,（42.4±6.6） g/L and （398.7±103.3） ng/mL,in patients with Child-Pugh class A or （157.7±22.3） g/L,（49.9±6.2） g/L and （509.6±122.9） ng/mL in patients with Child-Pugh class B（all P<0.05）;serum IL-10 levels decreased,while serum IL-2,IL-6 and sICAM-1 levels increased in patients with complications such as spontaneous bacterial peritonitis,hepatic encephalopathy or gastrointestinal bleeding. Conclusion Serum cytokine levels change as liver functions deteriorate, which might be helpful for clinicians to make managements in time in clinical practice.

Objective To investigate the effect of modified Sugiura’s operation on portal hemodynamics in cirrhotic patients with portal hypertension（PH）.Methods 56 cirrhotic patients with PH were admitted to our hospital between May 2013 and May 2015，and all patients received modified Sugiura’s operation. The free portal pressure （FPP） was measured before and after the operation. The hepatic reserve function was evaluated by indocyanine green 15-minute retention rate （ICGR15） and the effective liver blood flow （ELBF） was calculated. The portal vain diameter，portal vain blood flow （PVF），hepatic artery flow （HAF） and total hepatic flow （THF） were measured 1 week before，and 1 month and 3 months after devascularization surgery by ultrasonography.Results The modified Sugiura operation succeeded in this 56 patients with PH，and some complications，such as pulmonary infection and pleural effusion，wound infection，portal vein thrombosis，anastomotic stenosis and gastric fistula，etc，occurred，and all patients recovered after appropriate symptomatic，nutritional supports，antibiotics，albumin supplementation or plasma transfusion; the FPP after operation was （21.3±3.4）cmH2O，much lower than that before operation 【（32.5±5.0）cmH2O，P<0.05】；the EHBF，THF and PVF after operation were（0.5±0.1） ml/min，（1481.1±354.0） ml/min and（1046.1±258.0） ml/min，and they were（0.5±0.3） ml/min，（1574.1±326.0） ml/min and（1131.0±304.1） ml/min three months after operation，respectively，all significantly lower than those before operation [（0.7±0.3）ml/min，（1891.0±392.1） ml/min and（1523.1±291.1） ml/min，respectively，P<0.05]；the HAF after operation was （435.0±142.1）ml/min，and it was（443.0±183.1）ml/min three months after operation，both significantly higher than that before operation【（368.1±139.1） ml/min，P<0.05】；the ICGR15 after operation was （22.7±7.9）%，much higher than （19.3±5.5）% before operation（F=7.327，P<0.05）；the changes of portal vain diameters before and after operation were not significantly different（P>0.05）；at the end of one month and three months after operation，serum albumin levels increased obviously【（35.2±2.3） g/L and（36.8±1.7） g/L vs.（31.8±1.7）g/L before operation，P<0.05】；at the end of one month，peripheral platelet counts and white blood cell counts were （144.5±7.2）×109/L and （13.8±0.6）×109/L，and they were （98.1±10.6）×109/L and （4.2±0.8）×109/L three months after operation，both significantly higher than those before operation 【（75.3±6.7）×109/L and （3.4±0.3）×109/L，respectively，P<0.05】. Conclusion The application of modified Sugiura’s operation might improve liver function and portal-hepatic hemodynamics，reduce the portal pressure in patients with cirrhosis complicated with PH，which might decrease the morbidity and mortality of gastrointestinal bleeding.

Objective To investigate the clinical features and risk factors of patients with decompensated cirrhosis and sepsis.Methods 68 patients with decompensated liver cirrhosis were enrolled in our hospital between 2014 and 2018,and 30 patients were diagnosed with sepsis. Logistic regression analysis was applied to find the affecting risk factors for the occurrence of sepsis.Results Out of the 30 patients with sepsis,30 cases of pathogenic bacteria were detected,including 19 cases of gram-negative bacteria （Klebsiella pneumonia in 8,E. Coli in 6,and 5 cases of other gram-negative bacteria）. Eleven cases of gram-positive bacteria were detected （Staphylococcus aureus in 5,Streptococcus viridians in 2 and 4 cases of other gram-positive bacteria）. In patients with sepsis,the percentage of neutrophil was（74.34±2.88） %,blood creatinine level was （126.57±20.81） μmol/L,CRP was（48.93±10.28） mg/l,serum bilirubin level was（82.29±16.59） μmol/L,all significantly different compared to [（58.53±2.91）%,（74.69±3.24） μmol/L,（24.21±6.66） mg/l and（52.93±11.03） μmol/L,P<0.05] in patients without sepsis,while serum albumin level was （27.21±5.66） g/L,much lower than 【（31.83±7.98） g/L,P<0.05】 in the control;Logistic regression analysis showed that serum bilirubin and albumin levels were the independent risk factors for the occurrence of sepsis. Conclusion The common pathogen in deconpensated liver cirrhosis patients with sepsis is gram-negative bacillus,and the clinicians should take risk factors into consideration in this settings.

Objective The aim of this study was to investigate the prediction of early tumor recurrence by predictive nutritional index （PNI） and neutrophil/lymphocyte ratio （NLR） in patients with hepatocellular carcinoma （HCC） undergoing hepatectomy.Methods The clinical data of 237 patients with HCC were recruited in Anhui Provincial Hospital between January 2012 and December 2015,and all patients underwent partial hepatectomy. The PNI and NLR receiver operating characteristic curves（ROC） were plotted. Multivariate Logistic analysis was applied to predict the risk factors for postoperative early tumor recurrence.Results There were 128 patients with high （≥45.95） and 109 patients with low PNI score （<45.95）,and 99 patients with high （≥2.52） and 138 patients with low NLR score（<2.52）;the early tumor recurrence rate in patients with high PNI score was 51.6% （66/128）,much lower than 73.4% （80/109） in those with low PNI score（P<0.01）,and the early tumor recurrence rate in patients with low NLR score was 55.8% （77/138）,significantly lower than 69.7% （69/99） in those with high NLR score（P<0.05）;Univariate and multivariate Logistic regression analysis showed high PNI score（HR=2.036） 95% CI=1.113-3.722,P=0.021）,low NLR score（HR=2.235,95% CI=1.221-4.091,P=0.009） and advanced TNM staging（HR=2.540,95% CI=1.237-5.215,P=0.011） were the independent risk factors for early tumor recurrence after radical resection of liver cancer. Conclusion The calculation of PNI and NLR pre-operationally might help predict the early tumor recurrence after hepatectomy in patients with HCC.

Objective The aim of this study is to investigate the efficacyof cetuximab and KRAS gene mutation in the treatment of patients with primary liver cancer （PLC）.Methods A prospective study was conducted in 96 patients with PLC in our hospital from August 2014 to August 2017. All patients were treated with cisplatin,and the mutation of peripheral blood KRAS gene was detected by PCR. Logistic regression analysis was applied to find affecting efficacy factors.Results At the end of eight weeks,partial response （PR） was obtained in 59 （61.5%）,stable disease （SD） in 22 （22.9%）,and progressive diseases （PD） in 15（15.6%） patients with PLC;the blood KRAS mutation rate in 81 patients with PR/SD was 9.9%,much lower than 40.0% （P<0.05） in 15 patients with PD;the GGT-GAT and GGT-GTT mutation of condon 12 and GGC-GAC mutation of condon 13 in patients with PD were 13.3%,6.7% and 6.7%,significantly higher than 0.0%,0.0% and 0.0% （P<0.05） in patients with PR/SD;Logistic regression analysis showed that Child class,tumor type and PKRAS gene mutation were the independent factors affecting the efficacy. Conclusion The application of cetuximab in the treatment of patients with PLC might be efficacious,and the detection of blood KRAS gene mutation might be helpful for patient inclusion.

Objective To investigate the efficacy of combination of vincristine,apixamycin and cyclophosphamide （CAO chemotherapy regimen） combined with high frequency focused ultrasound ablation in the treatment of children with hepatoblastoma （HB） at stage III/IV.Methods The clinical data of 34 children with HB at stage III and IV recruited in our hospital between December 2010 and January 2016 were analyzed retrospectively. Out of them,16 patients t were treated with combination of CAO chemotherapy regimen and high-frequency focused ultrasound ablation,and 18 patients were treated with CAO chemotherapy regimen alone. All the children were followed-up for 24 months. The biochemical indicators,tumor relief,adverse reactions of chemotherapy and the outcomes of patients were compared between the two groups.Results At the end of three-month treatment,serum AFP level in the combination group was （43.2±5.4） μg/L,serum ALT level was （93.5±26.3） U/L,and serum AST level was （91.2±30.2） U/L,significantly lower than （55.3±6.2） μg/L,（197.1±57.8） U/L and （213.7±66.2） U/L in the control （P<0.05）,while blood Hb levels in the two groups were not significantly different （P>0.05）;the tumor remission rate in the combination group was 81.3%,significantly higher than 61.1% in the control （P<0.05）;the incidence of side effect in the combination was 18.8%,not significantly different compared to 27.8% in the control （P>0.05）;at the end of 24 month followed-up,the fatality rate in the combination group was 6.3%,not significantly different compared to 11.1% in the control（P>0.05）,however,the recurrence rate of intrahepatic tumor was 13.3% in combination group,significantly lower than 25.0% in the control（P<0.05）. Conclusion The CAO chemotherapy regimen combined with high-frequency focused ultrasound ablation in the treatment of children with stage III and IV HB might be efficient,which delay the tumor growth and reduce the recurrence rate after treatment.

Objective The aim of this study was to investigate the application of indocyanine green-mediated near-infrared light detection in patients undergoing cholecystectomy.Methods The clinical data of 45 patients with gallbladder carcinoma treated in our hospital between January 2016 and January 2018 were prospectively collected and analyzed. Intravenous injection of indocyanine green was given before surgery to guide finding the tumor fluorescence imaging during the operation. The anatomical features of the tumors in the isolated specimens were observed too.Results Forty-five tumors were found in 45 patients before operation,out of them,37 could show fluorescence in the surface of the tumors,and the depths and diameters of tumors with fluorescent manifestation were （0.4±0.2） cm and （6.3 ±2.1） cm,respectively,significantly different as compared to those in 8 tumors without fluorescent feature [（1.5±0.4） cm and （4.5±0.3） cm,respectively,P<0.05];in 45 patients,the in vitro tumor tissue specimens were cut open by the middle,and the sections showed strong fluorescence,among them,23 highly differentiated gallbladder carcinomas were with parenchymal imaging,4 out of 14 moderately differentiated carcinomas were with parenchymal imaging,and the other 8 poorly differentiated gallbladder carcinomas were without any imaging consistent with tumor surrounding tissue;at 1-year follow-up,no deaths were found,and 7 （15.6%） patients had tumor recurrence. Conclusion Indocyanine green-mediated near-infrared light imaging could show the location of the tumors,helping find the lesions that are commonly neglected by the routine examination.

Objective This study was aimed to investigate the enhanced magnetic resonance imaging(MRI) by gadolinium disodium sebacate （Gd-EOB-DTPA） in diagnosis of patients with focal liver lesions （FLL）.Methods A prospective study was conducted on 68 patients with suspected FLL by ultrasound and/or CT scan,and all the patients accepted Gd-EOB-DTPA enhanced MRI scan. The diagnosis of MRI was reevaluated by post-operational histopathological examination.Results The liver histopathological examination showed that hepatocullular carcinoma（HCC） in 36,intrahepatic cholangiocarcinoma in 6,mixed liver carcinoma in 8,hepatic focal nodular hyperplasia in 12,hepatic vascular leiomyolipoma in 4 and non-FLL in 2,while the enhanced MRI demonstrated that HCC in 37,intrahepatic cholangiocarcinoma in 7,mixed liver carcinoma in 4,hepatic focal nodular hyperplasia in 14,hepatic vascular leiomyolipoma in 2 and non-FLL in 4;the Kappa was 0.7 when the FLLs were diagnosed by MRI,with the sensitivity of 97.1%,specificity of 100.0%,positive predicting value of 100.0% and negative predicting value of 50.0%. Conclusion The application of MRI intensified by Gd-EOB-DTPA enhancement might be helpful in diagnosis of patients with FLL,which needs further validation in clinical practice.

Objective The aim of this study was to compare the efficacies on laparoscopic fenestration and ultrasound-guided puncture intervention for the treatment of patients with simple hepatic cyst （SHC）.Methods 94 patients with SHC were recruited in our Department of Interventional Ultrasound and Department of General Surgery between June 2017 and March 2018,and were randomly divided into control group and observation group,with 47 patients in each group. The patients in the control group were treated with laparoscopic fenestration,and those in the observation group were treated with ultrasound-guided puncture intervention. The liver function tests,adverse reactions and total effective rates were observed and compared between the two groups.Results One month after surgery,the total effective rates in both control group and the observation group were 100%;one month after surgery,serum levels of alanine aminotransferase（ALT）,aspartate aminotransferase（AST） and total bilirubin （TBIL） in the observation were （28.4±4.3） U/L,（28.5±2.3） U/L and （18.5±2.4） mmol/L,not significantly different as compared to （31.7±4.7） U/L,（31.3±2.4） U/L and （19.9±3.5） mmol/L in the control （P<0.05）;after surgery,the incidences of fever,abdominal distension and pain and vomiting in the observation were 14.9%,19.2% and 25.5%,significantly lower than 29.8%,42.6% and 48.9% （P<0.05） in the control. Conclusion The application of ultrasound-guided puncture intervention for the treatment of patients with SHC has the same total effective rate as with laparoscopic fenestration,which might reduce the incidence of adverse reactions,and is worthy for further investigations.

Objective To summarize the feature of magnetic resonance imaging（MRI） in patients alveolar hepatic echinococcosi （AHE） and complicated multiple organ invasion.Methods 210 patients with AHE were admitted to our hospital between February 2016 and January 2018,and all of them were confirmed by postoperational histopathologic examination. The imaging data of the patients were retrospectively analyzed,and the invasion features of MRI in brain,lung,and kidney were discussed.Results Out of the 210 patients with AHE,the hepatic lesions located in the left lobe,the right lobe and the left and right lobes were 26.2%,57.1% and 16.7%,respectively;the patients with brain invasion accounted for 12.9%,lung invasion for 17.1%,brain and lung invasion for 20.0%,brain and kidney invasion for 13.8%,and brain,lung and kidney invasion for 10.0%;the MRI feature of brain invasion presented with multiple round cystic lesions,that of lung invasion showed multiple 0.6 to 3.0 cm nodular parenchymal calcification,and the MRI sign of renal invasion was sand-like calcification around the cystic lesions. Conclusion The MRI examination has obvious advantages in diagnosis and differential diagnosis of patients with hepatic echinococcosis. We can observe the number,size and shape of the lesions,the calcification of the lesion wall and cystic contents,and the the adjacent organs involvement. We can also get information about the progress of the disease. Once the MRI scan shows that the patient has liver lesions,the attention should be paid to the examination of other important organs,such as brain,lung and kidney,so as to decrease the missed diagnosis.

Objective The aim of this study was to explore the value of color Doppler ultrasonography in the diagnosis of biliary complications in patients after liver transplantation,and to provide a guarantee for improving the survival rate of transplanted liver.Methods The clinical data of 54 patients underwent liver transplantation were analyzed in our hospital between May 2014 and September 2018. Color Doppler ultrasonography and cholangiography were carried out in all the patients.Results 14 patients were found to have biliary complications in our series of patients after liver transplantation,with biliary stricture in 9 and biliary sldge sediment and gallstone formation in 5;the diameters of the intrahepatic bile ducts and the common bile ducts in patients with biliary complications were （4.7±2.1） mm and （7.5±3.6） mm,both significantly larger than （1.2±0.5） mm and （4.3±1.6） mm in those without（P<0.05）;the wall thickness of the inner bile ducts and the common bile ducts were （2.3±0.4） mm and （4.7±1.5） mm,both significantly larger than （0.8±0.2） mm and （2.1±0.9） mm in those without（P<0.05）;we set the total bile duct diameter>6 mm,having bile duct wall echo enhancement and total bile duct wall thickness>3.5 mm as the diagnostic criteria,the sensitivity of color Doppler ultrasonography for diagnosing biliary complications after liver transplantation was 57.1%,and the specificity was 80.0%. Conclusion The application of color Doppler ultrasonography for the diagnosis of biliary complications after liver transplantation is noninvasive,convenient and repetitive,which might help the clinicians to make a comprehensive judgment and evaluation.

Objective To investigate the efficacy of percutaneous transhepatic choledochoscopic lithotripsy （PTCL） in patients with intrahepatic cholelithiasis after two-year follow-up.Methods 200 patients with intrahepatic cholelithiasis were enrolled in our hospital between March 2013 and March 2015,and were randomly divided into two groups with 100 in each,receiving PTCL or conventional open laparotomy. The operation parameters,complications and relapse of stone after two-year follow-up in the two groups were compared.Results The body mass index （BMI） was （24.2±2.2） kg/m²,the diameter of stone was （4.3±0.5） mm,and the percentages of stone location in the left,right and both hepatic ducts in PTCL-treated group were 56.0%,37.0% and 7.0%,not significantly different as compared to （24.0±3.0） kg/m²,（4.4±0.6） mm,55.0%,39.0% and 6.0% （P>0.05） in patients receiving open laparotomy;the operation finished in both groups and the stones were cleared out;the operation time was （154.3±21.8） min,bleeding volume was （96.3±15.8） ml,first exhaust was （1.1±0.5） d,and hospitalization time after operation was（7.7±0.9） d in PTCL-treated patients,all significantly shorter or less than（247.6±30.5） min,（190.0±10.5） ml,（1.9±0.4） d and （10.0±1.2） d,respectively,in the open laparotomy （P<0.05）;after operation,the incidence of complications,such as incision infection,peritonitis,pulmonary infection or bile leak in PTCL-treated group was 3.0%,significantly less than 11.0% （x²=4.902,P<0.05） in patients receiving open laparotomy;two weeks after operation,serum ALT and AST levels in PTCL-treated group were （43.9±9.5） u/l and （40.3±8.9） u/l,not significantly different as compared to （42.3±10.2） u/l and （43.4±10.5） u/l in open laparotomy （P>0.05）,while serum bilirubin level was （18.9±3.2） μmol/l,significantly lower than （23.0±3.1） μmol/l（P<0.05） in open laparotomy;at the end of one year follow-up,the stone relapse as showed by ultrasound examination in PTCL-treated patients was 2.0%,significantly lower than 9.0% （x²=8.901,P<0.01） in open laparotomy;at the end of two year follow-up,the cumulated stone relapse in PTCL group was 3.0%,significantly lower than 15.0% （x²=11.071,P<0.01） in open laparotomy. Conclusion The application of percutaneous transhepatic choledochoscopic lithotripsy for treatment of patients with intrahepatic cholangiolithiasis might accelerate the rehabilitation and reduce postoperative complications and stone relapse,which warrants further investigation.

Objective To observe the clinical efficacy of percutaneous transhepatic gallbladder drainage （PTGBD） and delayed laparoscopic cholecystectomy（LC） combination in the treatment of patients with acute cholecystitis （AC）.Methods A retrospective study was conducted on 94 patients with AC admitted to our hospital between August 2015 and August 2017. 47 patients in observation received PTGBD and delayed LC treatment,and another 47 in the control received emergent LC.Results In the observation group,the operation time was （83.2±34.1） min,significantly shorter than [（119.0±36.4） min,P<0.05] in the control,blood loss was （33.7±15.5） ml,much less than 【（60.4±16.7） ml,P<0.05】 in the control,the postoperative anal exhaust was （23.5±6.6） h,significantly shorter than 【（27.2±5.1） h,P<0.05】 in the control,the postoperative abdominal drainage was （3.4±2.0） d,significantly shorter than 【（9.1±3.1） d,P<0.05】 in the control,while total hospital stay was（11.2±4.7） d,significantly longer than【（8.3±3.0） d,P<0.05】 in the control;the rates of conversion to open surgery and direct open surgery in observation group were 4.3% and 0.0%,significantly lower than 17.0% and 12.8% （P<0.05） in the control;72 hours after operation,the while blood cell counts,serum ALT,AST and bilirubin levels were significantly lower than those in the control （P<0.05）;the incidences of short-term complications in the observation was 8.5%,much lower than 29.8% （P<0.05） in the control. Conclusion The application of PTGBD and thereafter delayed LC in the treatment of patients with AC is definitely efficacious,which might effectively reduce the conversion rate to open surgery and the incidence of post-operational Complications.

Increased portal pressure is associated with cirrhosis,which may lead to the development of portal hypertensive gastropathy（PHG）,and the hemodynamic and mucosal changes in gastrointestinal tract. PHG-related ruptured varices account for the majority of bleeding episodes in cirrhosis patients. This review focus on the research highlights of PHG in the past few years.

Portal vein thrombosis （PVT） is a common complications in patients with liver cirrhosis,often as a predictor of poor prognosis. There is a controversial veiws about anticoagulation treatment in dealting with PVT as the high risk of hemorrhage in this settints. There is no at present guidelines related in this field. However,there are increasing evidence showing that anticoagulant therapy offers a high recanalization in patients with PVT,without an increase of gastrointestinal bleeding risks. The application of anticoagulation decreases the morbidity in patients with PVT and might improve the liver functions. Moreover,the earlier the anticoagulation started,the higher the rate of recanalization the patients could obtain. Thus,cirrhosis patients are recommended to start the anticoagulation after a definite diagnosis of PVT as soon as possible. If the anticoagulation therapy does not work,the transjugular intrahepatic portosystem shunt（TIPS） or thrombolysis are alternative strategy for patients with liver cirrhosis. The patients might acquire a high rate of vascular recanalization after TIPS,while this technique is very complicate. The thrombolysis should be taken carefully because of a high risk of bleeding.